J AM ACAD DERMATOL Research Letters 1215

VOLUME 82, NUMBER 5

Skin damage among health care Table I. Clinical features of skin damage among
workers managing coronavirus first-line health care workers
disease-2019 Participants with skin
To the Editor: Since the outbreak of coronavirus Clinical features* damage (N = 526), No. (%)

disease-2019 (COVID-19) in December 2019, more Symptoms

than 200,000 health care workers from all over China Dryness/tightness 370 (70.3)
have been participating in the fight against this highly Tenderness 299 (56.8)
contagious disease in Hubei province, which is the Itching 276 (52.5)
Burning/pain 200 (38.0)
center of infection in China. Skin damage caused by
Skin lesions
enhanced infection-prevention measures among
Desquamation 327 (62.2)
health care workers, which could reduce their Erythema 260 (49.4)
enthusiasm for overloaded work and make them Maceration 210 (39.9)
anxious, has been reported frequently. Fissure 204 (38.8)
Previous studies have revealed that hand eczema Papule 173 (32.9)
is quite common in health care workers,1,2 and the Erosion and ulcer 53 (10.1)
risk factors include frequent hand hygiene and Vesicle 7 (1.3)
wearing gloves for a long time.3,4 Considering the Wheal 2 (0.4)
frequent hand hygiene and long-time wearing of Site
tertiary protective devices (N95 mask, goggles, face Nasal bridge 437 (83.1)
Cheek 414 (78.7)
shield, and double layers of gloves) among health
Hands 392 (74.5)
care workers during the epidemic period of
Forehead 301 (57.2)
COVID-19, we aimed to estimate the prevalence,
clinical features, and risk factors of this skin damage *With overlaps.
among them.
From January to February 2020, self-administered
online questionnaires were distributed to 700 in- significant risk factor in causing forehead skin dam-
dividuals, consisting of physicians and nurses who age (OR, 1.52; 95% CI, 0.93-2.50; P ¼ .66). The more
worked in the designated departments of tertiary frequent ([10 times daily) hand hygiene could
hospitals in Hubei, China. The questionnaire increase the risk of hand skin damage (OR, 2.17;
included questions about the condition of skin 95% CI, 1.38-3.43; P \.01), rather than a longer time
damage and the frequency or duration of several of wearing gloves (Table II).
infection-prevention measures (Supplemental Our study has some limitations. Firstly, we only
Material 1, available via Mendeley at https://data. studied 1 site with a single exposure factor, but some
mendeley.com/datasets/zknvry83v5/2). Finally, 542 sites could be related to more than 1 factor. The
individuals (Supplemental Material 2) completed the nasal bridge, for example, could be
study (response rate, 77.4%), with 71.4% (387 of 542) compressed by the N95 mask and goggles
working in isolation wards and 28.6% (155 of 542) simultaneously, although goggles were the main
working in fever clinics. factor. Secondly, possible risk factors such as
The general prevalence rate of skin damage participants wearing the N95 mask after work in
caused by enhanced infection-prevention measures daily life were not included.
was 97.0% (526 of 542) among first-line health care In conclusion, our study demonstrated that the
workers. The affected sites included the nasal bridge, prevalence of skin damage of first-line health care
hands, cheek, and forehead, with the nasal bridge workers was very high. Moreover, we found that
the most commonly affected (83.1%). Among a series longer exposure time was a significant risk factor,
of symptoms and signs, dryness/tightness and which highlights that the working time of first-line
desquamation were the most common symptom staff should be arranged reasonably. Besides, pro-
(70.3%) and sign (62.2%), respectively (Table I). phylactic dressings could be considered to alleviate
The health care workers who wore some medical the device-related pressure injuries, according to a
devices more than 6 hours had higher risks of skin prior study.5
damage in corresponding sites than those who did We would like to thank Xiaoxu Yin from Tongji
for less time (N95 masks: odds ratio [OR], 2.02; 95% Medical College School of Public Health for his sugges-
confidence interval [CI], 1.35-3.01; P \.01); goggles: tions about this paper and the health care workers who
OR, 2.32; 95% CI, 1.41-3.83, P \ .01), whereas a participated in our study for their support of this paper.
longer time of wearing a face shield was not a We especially want to express our deep respect to all
1216 Research Letters J AM ACAD DERMATOL
MAY 2020

Table II. The association between skin damage and related exposure factors
Participants with
Infection-preventive Participants skin damage in related
measures Participants, No. Variables (N = 526), No. (%) sites, No. (%) OR 95% CI P
N95 mask 542 #6 h/d 225 (41.5) Cheek: 155 (68.9) 1 [Ref]
[6 h/d 317 (58.5) Cheek: 259 (81.7) 2.02 1.35-3.01 \.01
Goggles 451 #6 h/d 186 (41.2) Nasal bridge: 141 (75.8) 1 [Ref]
[6 h/d 265 (58.8) Nasal bridge: 233 (87.9) 2.32 1.41-3.83 \.01
Face shield 265 #6 h/d 108 (40.8) Forehead: 52 (48.1) 1 [Ref]
[6 h/d 157 (59.2) Forehead: 92 (58.6) 1.52 0.93-2.50 .66
Gloves 113* #6 h/d 52 (46.0) Hands: 29 (55.8) 1 [Ref]
[6 h/d 61 (54.0) Hands: 39 (63.9) 1.41 0.66-3.00 .44
321y #6 h/d 131 (40.8) Hands: 100 (76.3) 1 [Ref]
[6 h/d 190 (59.2) Hands: 146 (76.8) 1.03 0.61-1.74 [.99
Hand hygiene 434 #10 times/d 113 (26.0) Hands: 68 (60.2) 1 [Ref]
[10 times/d 321 (74.0) Hands: 246 (76.6) 2.17 1.38-3.43 \.01

CI, Confidence interval; OR, odds ratio; Ref, reference.

*These participants are limited to those who wore double layers of gloves and washed hands 1-10 times/d.
y
These participants are limited to those who wore double layers of gloves and washed hands [10 times/d.

first-line health care workers for their dedication in the
fight against COVID-19.
Jiajia Lan, MD,a,b Zexing Song, BS,a,c Xiaoping
Miao, PhD,d Hang Li, MD, PhD,e Yan Li, MD,
PhD,a,b Liyun Dong, MD,a,b Jing Yang, MD,
PhD,a,b Xiangjie An, MD, PhD,a,b Yamin Zhang,
MD, PhD,a,b Liu Yang, MD, PhD,a,b Nuoya Zhou,
MD,a,b Liu Yang, BS,a,f Jun Li, MD, PhD,g
JingJiang Cao, MD, PhD,h Jianxiu Wang, BS,i
and Juan Tao, MD, PhDa,b
From the Department of Dermatology, Union Hos-
pital, Tongji Medical College, Huazhong Univer-
sity of Science and Technology, Wuhana; Hubei
Engineering Research Center for Skin Repair and
Theranostics, Wuhanb; the Second Clinical Med-
ical College, Chongqing Medical University,
Chongqingc; the Department of Epidemiology
and Biostatistics, School of Public Health, Tongji
Medical College, Huazhong University of Sci-
ences and Technology, Wuhand; the Department
of Dermatology and Venerology, Peking Univer-
sity First Hospital, Beijinge; the Hunan Normal
University School of Medicine, Changsha, Chi-
naf; the Department of Dermatology, the Central
Hospital of Wuhan, Tongji Medical College,
Huazhong University of Science and Technology,
Wuhang; Department of Dermatology, Renhe
Hospital, Three Gorges University, Yichangh;
and Department of Dermatology, Xiangyang
Hospital, Hubei University of Chinese Medicine,
Xiangyang, China.i
Dr Lan and Zexing Song contributed equally to this
work.
Funding sources: This work was supported by HUST
COVID-19 Rapid Response Call Program
(2020kfyXGYJ056) and Hubei Provincial Emer-
gency Science and Technology Program for
COVID-19 (2020FCA037).
Conflicts of interest: None disclosed.
IRB approval status: Not applicable.
Accepted for publication March 9, 2020.
Reprints not available from the authors.
Correspondence to: Juan Tao, MD, PhD, Department
of Dermatology, Union Hospital, Tongji Medical
College, No. 1277 Jiefang Ave, Wuhan, Hubei,
430022 China
E-mail: tjhappy@126.com
REFERENCES
1. Skoet R, Olsen J, Mathiesen B, Iversen L, Johansen JD, Agner T.
A survey of occupational hand eczema in Denmark. Contact
Dermatitis. 2004;51:159-166.
2. Flyvholm MA, Bach B, Rose M, Jepsen KF. Self-reported hand
eczema in a hospital population. Contact Dermatitis. 2007;57:
110-115.
3. Hamnerius N, Svedman C, Bergendorff O, Bjork J, Bruze M,
Ponten A. Wet work exposure and hand eczema among healthcare
workers: a cross-sectional study. Br J Dermatol. 2018;178:452-461.
4. Lee SW, Cheong SH, Byun JY, Choi YW, Choi HY. Occupational
hand eczema among nursing staffs in Korea: self-reported
hand eczema and contact sensitization of hospital nursing
staffs. J Dermatol. 2013;40:182-187.
5. Bishopp A, Oakes A, Antoine-Pitterson P, Chakraborty B,
Comer D, Mukherjee R. The preventative effect of hydrocolloid
dressings on nasal bridge pressure ulceration in acute
non-invasive ventilation. Ulster Med J. 2019;88:17-20.
https://doi.org/10.1016/j.jaad.2020.03.014